Role of Leucocytosis and Neutrophilia in Diagnosis of Appendicitis and Differentiating Complicated from Uncomplicated Appendicitis

Authors

  • Rakesh Roshan Sthapit Assistant Professor, Department of General Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepa
  • Pramod Kumar Yadav Assistant Professor, Department of General Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • Anira Vaidya Assistant Professor, Department of General Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

Keywords:

Acute appendicitis, Complicated appendicitis, Leucocytosis, Neutrophilia.

Abstract

Introduction: Despite advances in diagnosis of acute abdomen, diagnosis of acute appendicitis still proves difficult at times. While negative appendicectomy subjects the patients to unnecessary morbidity, the risk associated with misdiagnosis of appendicitis and delayed surgery cannot be ignored either. This risk is further increased in patients with complicated appendicitis characterized by appendicular perforation, gangrene or abscess formation. Although, appendicitis is usually associated with leucocytosis and neutrophilia, there have been studies which conclude that normal leucocyte counts and absence of neutrophilia cannot rule out appendicitis. In this regard, we have sought to assess the role of total leucocyte counts and neutrophilia in diagnosis of acute appendicitis and differentiation of complicated from uncomplicated appendicitis.

Method: A retrospective review of charts was performed to identify all patients who underwent appendicectomy between July 2018 and December 2018 in the Department of General Surgery at Bir Hospital. Based on intra-operative findings and histopathology, patients were divided into three groups: uncomplicated appendicitis, complicated appendicitis and non-appendicular pathology. Complicated appendicitis was defined as perforated or gangrenous appendicitis or appendicular abscess formation. Total leucocyte counts (TLC) and neutrophil percentages were compared among the three groups. Receiver operating characteristic (ROC) curve analyses were done to find out cut-off levels and accuracy of total leucocyte counts and neutrophil percentages to discriminate appendicular pathology from non-appendicular and also to differentiate complicated appendicitis from uncomplicated appendicitis.

Result: Out of 150 cases, appendicitis was histopathologically confirmed in 136 (90.67%) cases. Negative appendicectomy rate was 9.33%. Among appendicitis cases, mean age was 24 ± 2.2 years and male to female ratio was 2.49:1. Complicated appendicitis was found in 36 (26.47%) patients. There was no significant differences in mean of TLC among patients with uncomplicated appendicitis (12592/mm3), complicated appendicitis (12524/mm3) or non appendicular pathology (10757/mm3) (p=0.278). On ROC curve analysis, area under the curves (AUC) of TLC and neutrophil percentages were 0.676 and 0.707 respectively for discriminating appendicular from non-appendicular pathology. For differentiating uncomplicated appendicitis from complicated, AUCs were 0.527 and 0.516 for TLC and neutrophils respectively.

Conclusion: Neither TLC nor neutrophil percentages have sufficient discriminatory power to diagnose acute appendicitis or to differentiate between uncomplicated and complicated appendicitis.

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Published

2020-12-25

Issue

Section

Orginal Articles